San Francisco's unique universal health care program costs significantly less than private insurance plans, according to a new report by the Department of Public Health.

But public health officials and private insurers agree private insurance is better - if you can get it.

The report looks at the total cost of running Healthy San Francisco - $113 million this fiscal year - divided by the number of participants and the number of months they were on the plan. The average cost per person per month is $280. Of that, the city pays $199, and participants' quarterly fees, a state grant and employer contributions make up the rest.

The average San Francisco resident has more than 100 options for private insurance on the open market if they don't receive coverage through an employer. The report looks at two of those plans, both deemed "high quality" by the department. The average price for a 45-year-old - the average age of a Healthy San Francisco participant - is $388 per month through Kaiser and $618 per month through Anthem Blue Cross, according to the report.

"From the point of view of financial viability, this is the first proof we have that Healthy San Francisco works," said Mitch Katz, director of the health department.

Katz hastened to add that the news shouldn't encourage people to ditch private insurance plans they already have. Healthy San Francisco - which started in July 2007 and has 37,000 participants - isn't insurance because it doesn't follow participants outside city borders.

If a participant has a heart attack in Oakland, belonging to Healthy San Francisco means nothing, whereas a Kaiser or Anthem Blue Cross participant would be covered.

"Commercial health plans offering insurance in California have to provide hospital physicians and medical group coverage from Eureka to San Diego," he said. "That's a very different endeavor than just providing coverage within one county."

But Healthy San Francisco is especially useful for those who can't obtain private insurance because of pre-existing medical conditions. The city plan would be just as readily available to someone suffering from AIDS or cancer as someone who is perfectly healthy.

"We're not advocating that this is a better product," Katz said. "All we're saying is for the people who can't afford insurance or can't get it, this is comprehensive coverage for a lot less per month for the city."

Some patients, activists and medical staff, though, say the universal health care plan isn't working as well as Katz and Mayor Gavin Newsom, who has made it a centerpiece of his gubernatorial run, would like people to believe.

They point to pregnant women with scheduled appointments forced to wait up to five hours to see their doctors and the severe backup for mammograms at San Francisco General. Long waits for care is one of the most frequent complaints of universal health care participants in Canada and Europe.

"Our contention will never be that Healthy San Francisco is perfect," Katz said. "What we want to be is the program that provides comprehensive care for everyone who needs it. If that means people have to wait longer, we'll keep working on that."